Clinical Decision-Making in Emergency Medicine

Geary U, Kennedy U

This review of the bases for decision making in emergency medicine argues that the

process involves more than a simple an action-reaction sequence. Instead, decisions are

governed by cognitive processes that favor the development of strategies and complex

skills that enable the physician to act appropriately. Influential factors include physicianrelated

attributes as well as emergency service- and patient-related ones. Two models of

clinical reasoning are defined. In the first system, reasoning is instinctive, driven by

pattern recognition. The ability to make decisions with this system is acquired over time,

through experience. In the second system, decision making is systematic and analytical.

More reliable than the first system, this second one is less prone to error, although it

takes longer to learn and is more costly. The most effective way to cope with most

clinical situations is usually to combine these 2 cognitive approaches. This review

describes key aspects of decision making processes that aim to minimize the risk of

making mistakes in emergency medical practice.

Geary U, Kennedy U